Perioperative Airway Complications following Pharyngeal Flap Palatoplasty

Abstract

This study was performed to determine the incidence and types of perioperative airway complications after pharyngeal flap palatoplasty. We conducted a retrospective chart review of 88 patients who underwent correction of velopharyngeal insufficiency between April 30, 1983, and April 30, 1997, in a tertiary care hospital. Some degree of airway obstruction developed in 7 patients. One child developed laryngobronchospasm and required immediate endotracheal intubation. He was successfully extubated without sequelae. Another patient developed severe obstructive sleep apnea and required flap revision. A third patient was found asystolic and apneic. She was immediately intubated; however, she subsequently died. Two patients aspirated blood, presumably resulting in pneumonia. They were managed with parenteral antibiotics. Another child developed worsening sleep apnea and required flap revision. One patient developed nasal obstruction that resolved with time. Airway compromise in patients who undergo pharyngeal flap palatoplasty can be a potentially fatal complication. Careful surveillance should be maintained over patients with underlying neurologic, craniofacial, or cardiopulmonary disorders.

Perioperative adverse airway events in cleft lip and palate repair

“…2 Fatality due to airway compromise has also been reported following cleft lip and palate surgery. 3,4 There are a few studies on perioperative complications in cleft lip and palate surgery, but these are largely from developed nations. 3,[5][6][7][8][9] In most developed countries, cleft lip and palate care has evolved into organised cleft teams based in regional or supraregional centres.…”

Anaesthesia for Cleft Lip and Palate Surgery: Study from a Hospital of Eastern Nepal

“…The frequency of intraopera ve respiratory complica ons reported by Kulkarni et alwas 2.4% in cle lip 27 and 8.7% in cle palate repair. Adverse respiratory events occur usually during intuba on and extuba on but were seen more frequently immediately a er tracheal extuba on 29 than during induc on of anesthesia. The most commonly seen respiratory adverse events in our study were respiratory obstruc on and coughing but as severe complica ons laryngospasm and desatura on also occurred more a er the extuba on.…”

“…The most commonly seen respiratory adverse events in our study were respiratory obstruc on and coughing but as severe complica ons laryngospasm and desatura on also occurred more a er the extuba on. Coughing itself is usually not a complica on, it is a physiological response to protect the airway from 29 aspira on. However, coughing may increase blood pressure, heart rate and persistent coughing might be associated with other complica ons like saliva on, airway obstruc on, 29 wound bleeding, desatura on and laryngospasm.…”

“…Coughing itself is usually not a complica on, it is a physiological response to protect the airway from 29 aspira on. However, coughing may increase blood pressure, heart rate and persistent coughing might be associated with other complica ons like saliva on, airway obstruc on, 29 wound bleeding, desatura on and laryngospasm. complica ons and the anesthesiologist is fully responsible for the care of the pa ents from induc on of anesthesia to 34 full recovery.…”

Dimensões nasofaríngeas e queixas respiratórias em indivíduos com insuficiência velofaríngea submetidos à cirurgia de retalho faríngeo

“…Diferentes estudos da literatura relataram elevado índice de sucesso desse tipo de cirurgia, em termos de redução ou eliminação dos sintomas de fala (Smith et al 1963, Subtelny et al 1970, Owsley Junior et al 1970, Schulz et al 1973, Leanderson et al 1974, Brondsted et al 1984, Van Demark e Hardin 1985, Hall et al 1991, Schmelzeisen et al 1992, Eufinger et al 1995, Morris et al 1995, Sloan 2000. Entretanto, o retalho faríngeo está, ao mesmo tempo, associado a um potencial significante de comprometimento das vias aéreas superiores, podendo levar à hiponasalidade, à obstrução nasal crônica, ao ronco e, à apnéia obstrutiva do sono, que podem trazer conseqüências graves aos pacientes (Bzoch 1964, Thurston et al 1980, Kravath et al 1980, Orr et al1987, Velasco et al 1988, Pensler e Reich 1991, Caouette-Laberge et al 1992, Ysunza et al 1993, Sirois et al 1994, Valnicek et al 1994, Lesavoy et al 1996, Zuiani et al 1998, Wells et al 1999, De Serres et al 1999, Peña 2000e Liao et al 2002. Como a fissura determina deformidades nasais que, com freqüência, reduzem as dimensões da cavidade nasal e, por conseqüência, aumentam a resistência nasal ao fluxo aéreo respiratório, é possível que nestes pacientes a colocação de um retalho na região da velofaringe seja um fator a mais a comprometer a permeabilidade nasal (Warren et al 1974).…”